Learn more about Peter Attia’s digital program
Note to readers: This post was written in September of 2012. PLEASE do not ask me why I eat ‘this’ or why I don’t eat ‘that’ — as what is shown here does not necessarily reflect what or how I eat today (or more importantly, how you should eat). My diet evolves constantly, due to my constant tweaking and self-experimentation. Over time, I’ll share it here and there, but what I eat is not at all the focus of this blog. I ask that you refrains for asking questions about what I eat your comments.
For reasons I don’t fully understand the most read post on this blog is one I wrote very quickly and with very little thought. I wrote it in response to a question I’m asked all the time, “What do you actually eat?” The post, aptly titled, What I actually eat, has more than twice the traffic of the next three most read posts combined. Go figure.
After a full year in “strict” (i.e., no “cheat” days) nutritional ketosis I wanted to experiment with other eating patterns. I had been reading about intermittent fasting (IF), and had a few discussions and exchanges with Mark Sisson and Robb Wolf about it. Though I don’t know Brad Pilon or Martin Berkhan personally, I’d also read a few interesting things they had written.
Why the change?
My curiosity was sufficiently piqued to break a golden rule – if it ain’t broke, don’t fix it.
I was very happy after a year of nutritional ketosis, but I did wonder if I could improve on a few things. For starters, as my cycling season was about to ramp up, I wondered what it would be like to weigh 75 kg (165 pounds) instead of my steady-state weight of about 78 kg (172 pounds). I know 3 kg does not sound like a lot, but it can make a huge difference when riding up Mount Palomar, assuming one can preserve power output. I also liked the idea of not spending so much time eating. As you probably know, I’m pretty obsessive about how I utilize the 168 hours in each week and resent anything that takes me away from my family, my work, and my training. (This includes sleep, which I wish I could figure out a way to thrive without.)
In the end, I think Mark Sisson finally just egged me on enough to agree to at least give it try – even just one day per week. And with that, I embarked on the next phase of my nutritional odyssey.
I decided, in early May, to start with the following protocol: one meal per 24 hours, twice a week. On the other 5 days I consumed my usual keto-diet. On the two IF days I would just eat one meal at around dinner time. I still consumed normal amounts of liquids (water, coffee, tea) and supplements (see list below), with one exception – on fasting days I doubled the amount of sodium I supplemented via bouillon from 2 gm per day to 4 gm per day.
Like all nutritional changes, this one took some getting used to. Because I exercise in the mornings, on fasting days I would get pretty hungry by about 10 or 11 am. Interestingly, though, by about 2 pm, as my blood glucose levels would be between 60 and 70 mg/dL, I would start to feel completely fine. In fact, by about 5 or 6 pm, just before eating my meal, I found I wasn’t really hungry. This may have been due to the fact that my B-OHB levels were usually above 3 mM by this time of day.
Why do I call it “IFIK?”
Not surprisingly, after eating 100 gm of protein and 40 gm of carbohydrates in one sitting, my B-OHB levels would fall, often below 0.5 mM, the practical threshold of nutritional ketosis. Usually within 24 hours I’d be back to my normal levels, generally between about 1 and 2 mM. But, the cycling in and out of ketosis was new to me, hence the phrase “intermittent fasting, intermittent ketosis,” or “IFIK.” I guess you can see why I didn’t end up in marketing – “if-ik” doesn’t really have a nice ring to it.
The purpose of this post is not to provide a detailed overview of IF or ketosis, but rather to address the following common questions I often get asked in response to the original post on what I ate:
- Question: Peter, why do you eat so much dairy? Answer: I don’t. That was a year ago. I did eat a lot of dairy, and seemed to tolerate it quite well. I realize that’s not true for everyone. Regardless, I seem to eat much less today.
- Question: Peter, is ketosis for everyone? Answer: Of course not. Besides oxygen and water, few things are.
- Question: Peter, why do you eat so much meat? Answer: I don’t. In fact, some days I don’t eat any. Other days I do. I obviously don’t think there is anything harmful with eating meat (read this post for a refresher), but I’m quite happy eating lots of non-meat items, too.
- Question: Peter, how can anyone possibly do anything athletic without carb loading? Answer: It’s easy. Anyone can do it, if they are just patient and let their body adapt.
- Question: Peter, you eat like a freak (ok, not really a question!) Response: And your point is?
What happened after several months of IFIK?
Interestingly, I did lose weight. After briefly hitting 163 to 164 pounds, I settled out at where I am right now, about 165 to 166 pounds, right at my 75 kg target. I have not yet repeated a DEXA scan to confirm, but I suspect I lost a bit of muscle, along with more fat, probably at about a 1:2 ratio. My last DEXA measured a body fat of about 9%, and I suspect I’m about the same, though my waist is half an inch smaller than when I started, so I may be closer to 8%.
Why do I think this happened?
In the IF community there are really two (maybe more) theories on why I lost weight. I won’t describe them here in any detail, but will do so in subsequent posts. One hypothesis is that I’m simply consuming fewer of the same high quality calories than I did before. The other hypothesis is that the physiologic response to IF (rather than the response to prolonged fasting) is to increase my REE during the period of IF, possibly through the up- and or down-regulation of various hormones. Of course, it could be a combination of these, or something entirely different, too.
Drumroll….
Before getting to the part that folks who are still reading probably care about, let me point out a few differences between what I eat today and what I ate a year ago.
- I consume, on average, fewer calories per day. I am also lighter, and we know TEE varies with body mass, so it’s not surprising that most days I am not eating over 4,000 kcal, as I used to. Of course, one might argue my body has become more metabolically efficient at utilizing substrate, and so my REE is lower than it was a year ago. Finally, I do exercise less than last year. Hence, there are many explanations for this difference.
- I consume less dairy. Don’t read too much into this. There is nothing deliberate about it, just an observation of my behavior.
- I consume less meat of all varieties. Again, don’t read too much into this. I have no explanation except that I seem to crave it in lower amounts and less frequently.
- I consume more overall carbohydrates, though still virtually zero sugar or refined carbohydrates. Most of this additional carbohydrate is in the form of nuts and SuperStarch.
- I consume virtually zero sugar substitutes, except for the little bit in my SuperStarch and protein powder (sucralose). I also drink, at most, about one diet soda per month.
- I spend less money on food.
- I spend less time eating.
- Currently I only eat three meals per day about once a week. I eat two meals per day probably 4 times per week, and one meal per day twice per week.
To calculate the nutritional content of my intake I use a piece of software called Nutritionist Pro, which is not for the faint of heart. It’s one step removed from a DOS prompt. In addition to costing about $600 a year, it’s not exactly user-friendly. I’d probably describe it as “user-hostile,” actually. But, it’s really accurate and has a database that is unrivaled. The reports, once you learn how to generate them, are very good, also.
Three consecutive days of representative eating
Keep in mind, I don’t count my calories or weigh my food normally. I do it periodically, such as at this time, when I’m curious as to what I’m actually eating. I believe I’m able to do so without eliciting the Hawthorne Effect, but obviously one can never be positive.
Tuesday
- 7 am — morning workout – flat intervals on bike (75 minutes).
- 1 pm – Nicoise salad:2 cup butterhead lettuce, 1 tomato, 10 black olives, 8 oz tuna steak, 1 hard boiled egg, 0.5 cup red onion, 2 oz lemon juice, 4 tbsp olive oil, 1 tbsp mustard.
- 7 pm – Chicken salad with nuts:2 cup romaine lettuce, 1 tomato, 0.5 cup cucumber, 2 oz cashews, 2 oz walnuts, 8 oz chicken breast, 6 tbsp olive oil, 2 tbsp balsamic vinegar.
Daily totals:
Carbohydrate – 89 gm
Protein – 131 gm
Fat – 218 gm (about 15% SFA, 70% MUFA, 15% PUFA)
Calories – 2,900
Wednesday
- 6 am — morning workout – high intensity dry land (90 minutes).
- 3 pm – The “Peter Kaufman shake” (named after my good friend, Peter Kaufman at Generation UCAN, who hooked me up with the recipe):
4 oz heavy cream, 8 oz zero-sugar almond milk, 1 pack chocolate protein SuperStarch, 2 tablespoons almond butter, 8 gm additional glutamine, 1 tray of ice cubes (blended to smoothie consistency). - 7 pm – Chicken-nut omelet:
4 eggs, 0.5 avocado, 3.5 oz cheddar, 3 oz red onion, 2 oz walnuts, 2 oz cashews, 4.5 oz chicken thigh, 2 tbsp butter
Daily totals:
Carbohydrate – 60 gm (30 gm of which is SuperStarch)
Protein – 151 gm
Fat – 226 gm (about 40% SFA, 35% MUFA, 25% PUFA)
Calories – 2,800
Thursday
- 7 am — morning workout – hill intervals on bike (75 minutes).
- 5 pm – Attia super salad:
1.5 cup romaine lettuce, 0.5 cup cucumber, 0.25 cup mushroom, 1 tomato, 3 oz sliced T-bone steak, 2 oz cashews, 2 oz peanuts, 2 oz macadamia nuts, 8 tbsp olive oil, 2 tbsp balsamic vinegar. - Between 6 and 8 pm – after-dinner snack consisting of:
3 oz cashews, 1 oz almonds, 2 oz peanuts, 1 oz macadamia nuts, 2 cups of coffee with a total of 6 tbsp heavy cream.
Daily totals:
Carbohydrate – 94 gm
Protein – 93 gm
Fat – 369 gm (about 20% SFA, 65% MUFA, 15% PUFA)
Calories – 3,800
My daily supplements
Note: I am only listing the products I use, and not trying to convince you that my brand of vitamin D is superior to another. If I feel strongly about a product, I note it. But this is not a product pitch. I don’t make one penny off you buying any of these products.
Fish oil
1 tablespoon of Carlson’s Very Finest Fish Oil, providing 2,400 mg EPA and 1,500 mg DHA. I do feel this is a superior product and I’ve had detailed toxicology analytics conducted on the product to confirm the absence of lead, arsenic, mercury, and other toxins.
Vitamin D
5,000 IU D3 in gel capsule, by NOW.
Magnesium
400 mg magnesium oxide by Nature Made.
Sodium
2,000 mg in the form of bouillon, typically by Knorr.
MCT oil
Either 2 or 3 tablespoons, depending on activity level, by NOW.
Probiotic
2 capsules of Mark Sisson’s Primal Flora, providing 60 billion CFU. The reason I use Mark’s product is because I know and trust him, and I know how much homework he did in formulating this product.
One of the topics I’m currently getting steeped in is gut biota, and I’m hanging out a lot with a San Diego expert on the topic, UCSD Professor Larry Smarr, who has repeatedly sequenced his entire gut biome, with the help of Craig Venter at Synthetic Genomics and others at MIT. As Larry points out, the challenge of “moving the needle” with probiotics is that they only provide the aerobic bacteria while, of course, most of our gut biome is anaerobic. Stay tuned for much more on this topic.
Closing thoughts
- My performance, especially in light of my reduced training volume (or maybe because of it!) has not deteriorated. In fact, this week I had 3 best times in 3 of the activities I do weekly (tire flipping/sledge hammer/plyometic routine (1:04); short sprint up 15-18% grade (0:39), and long sprint up 8% grade (3:29)). It’s possible the added carbohydrate, relative to my constantly ketotic state, has facilitated this, despite consuming about 15% of the carbohydrate I used to consume on my “standard American diet” circa 2008.
- I will discuss the impact on my biomarkers in a separate post.
- The only drawback I’ve noticed of IFIK so far is that I’ve inadvertently turned my daughter off nuts. About 4 months ago, after having three consecutive identical dinners (chicken-nut-salad), she called my wife into her room as she woke up and said, “Mommy…we need to talk. We need to have something different for dinner tonight. We can have steak…we can have sausage…we can even have regular salad without nuts…but I can’t have nuts in my salad anymore!” Poor girl… So now I have to make my salads separately.
Photo by Dan Gold on Unsplash
What a coincidence. I got my blood work and have had one appointment with Dr. Dall. I am being told to cut my saturated fats. I recalled reading something on your cholesterol series where you were talking about certain recs you make for ApoE4, though nothing specific.
Having 2 copies of the E4 allele (quite rare — about 1-2% of the population) pretty much always requires medical intervention to minimize CV risk. One copy of 4 and one of 3 or 2, less so, but still needs to be in the hands of a competent provider.
Susie –
I have had similar experience, where LDL-P went very high on high fat/low carb diet. It came down some
on cutting down on SFA(all pasture Chicken sans skin, low carb) but not enough. I am now on my 3rd iteration with only oily fish and <=50gm carbs. If this fails to lower LDL-P(I am concordant) then it has to be genetic and I will have to be medicated, I believe.
I will be interested in your followup experience with Dr. Dall, if you will share.
Thanks.
Indy M.
Sunnyvale, CA
Peter, the amount of information you share on your blog is amazing – I learn something new every time I come here and reading your posts and replies and your helpfulness and patience with your readers is truly inspiring. So maybe my question is kind of dumb but here it is – with all of this new information about cholesterol and the advance testing that is now available why is it that members of the medical profession (and I am here referring to cardiologists at excellent hospitals with highly rated heart programs I have recently had personal experience with) still only rely on the standard lipid profile? What can a patient say in response to these doctors when it was already obvious that the standard profile had Not predicted a recent cardiac event?
A separate thank you to Maryann for the information regarding certified lipidologists!
That’s a great question, Joanna, and I can only speculate (which I hate to do, with respect to other people’s behavior). My guess is cognitive dissonance. Read the book “Mistakes were made (but not by me)” and you’ll have — I believe — a good idea of what may be going on.
Thank you Joanna, that is so nice of you! I hope it helps!
Joanna,
Besides the enormous amount of new information that may be overwhelming the vast majority of our doctors and hospitals to absorb it all and put into practice, there is another factor that may drive the use of only the standard lipid panel and that is insurance companies and perhaps, Medicare and Medicaid. It may be difficult to get insurance companies to agree to pay for the newer tests. Many people may balk at paying out of pocket additional costs because they may not understand that the newer tests may give them better information . It is also possible that the person who does all the coding now a necessity before anything is actually done ( that happens now where I live, may not be true elsewhere) may miss the correct code and you may end up with the other test being performed. There are thousands and thousands of different codes and though the coders make every effort to code correctly, it still ends ups with costly mistakes being made by all from the medical staff, doctors and hospitals.
You might want to check with your insurance company about getting the newer tests, cost invovled and the coding and take that with you on your visit. An you just may have to be gently persistent to get what you want.
Peter, thank you so much for this blog.
You have said that you plan to address APO E in your cholesterol series. In the meantime, generally, what is the state of knowledge about the recommended diet for someone with the APOE4 allele? Can you provide links or references for information?
And a question for Susie, were you saying that Dr. Dall recommends a low saturated fat diet for APOE4? That would say the low carb approach is contraindicated for APOE4?
I’m looking into this at this moment. Perhaps the more important question is the role of dietary fat, especially SFA, based on apoA-II genotype.
I “fully understand” why this is the most popular post. Despite what you represent and what differentiates you and your nutrition project (critical thinking, science, unwavering pursuit of truth amidst the noise of fads, media, pop culture, politics…), the very things that draw readers to admire and respect you cannot drown our desire for both some concrete or quick answers (if we should wish to adopt or try out what is working for a clearly outstanding individual), and our psychological curiosity to simply get a somewhat intimate snapshot of a personality. I think it’s also the “testimonial appeal” of it. It’s an example of one of the strong pulls that fad diets are either subject to or whose proponents purposely and cynically employ. It’s ironic and unintentioned, but illustrative, I think.
Thanks you so much for being you and working with Gary and others to change the world in a positive way.
I think you’re right, CJ. I guess I should embrace it.
what i’ve eaten today, trying to get into nutritional ketosis state. I was hoping someone would comment on it? Give me ideas on where to look online for more meal ideas perhaps? Anything helps, I’m completely new to eating all this fat. I used to avoid it like the plague.
1 tsp coconut oil & 1 1/2 tbsp coconut manna
black coffee, water
walking carrying 40lb child ~30min
3 1/2 oz blk fst ham
65g macadamia nuts
water
walking again carrying child ~20 min
3 eggs in 1 tsp coc oil with
2 oz feta & 1 oz fromage frais
Now I have a headache and feel a bit sick to my stomach. I’m drinking peppermint yerba mate tea…
It seems I’m already at 40g carbs and close to 60g protein. What can I possibly eat for dinner that will be basically pure fat? I was going to cook the rest of my ground beef in coconut milk and red curry with spinach and lettuce (its my new favourite dish) but that would put me way over carbs from the veg.
I’m aiming for no more than 40g carbs, should be lower I bet and protein based on weight around 80g tops. The rest being fat. Considering what I ate today, I’m stumped on limiting carbs further. I feel like eating a head of lettuce AND a head of celery – I want that watery juicy crunchy greenery!
This is an AMAZING site/blog which I just found 2 days ago, and I, personally for body recomposition and also my brain (mental health, energy, focus) have decided to experiment with a keto diet. I just don’t know how much cheesy eggs I can eat. I’ll need to research variety 🙂
Thanks for putting all this out there. I’m fascinated by nutrition and it’s effects on the body & mind. I’ve had great success with raw vegan in the past, who knows, I might return to that – but my body is loving the red meat after 8 years vegan.
I have been on the LCHF now for the last 4 months and lost 25 lbs and as Jordan above, I have all my family following this with great success and well being. I am a physician in the Bay area, and finding this diet and the information we can get from doing NMR, is incredible. But more incredible is that nobody talks about or teach in the residency programs. Now, I do it in all my patients, and for sure in my diabetic patients, obese, or metabolic syndrome. Even when the other day refer a patient to a cardiologist with NMR results, he was surprise that I knew about this test. He even asked me “How do you know that”. I think still a lot of ignorance in the medical comunity and laboratories. One of my patients went to the UCSF laboratory and they did not know what NMR was.
But I want to tank you for all the information, time and education you are giving to this your community of high fat low carb dieters.
Pedro, there are a lot of readers in the Bay Area in need of a good doctor. If you’re willing, it might be worth posting your office info in this thread for such patients.
Thanks for the great information. I’m looking forward to your blog on superstarch as I’m a big fan of it. I’m curious if you have tried Vespa and if so how would you combine the two for running a marathon?
Stay tuned…that’s the next topic coming up. No, I have not tried Vespa. How is it different than some honey-flavored water? I’m sure it’s more, but I can’t tell by looking at the ingredient list.
I am a 59 year old female with osteoporosis (t score -2.7). I was told that a high protein diet should be avoided since it makes the body more acidic. I was wondering how your method of eating will affect bone health. Can you give me some guide lines. I am not taking any prescription meds (e.g. Actonel,etc.). I am Caucasian , 5’5″. 137 lbs. I walk 4 miles 3x/ week, am a Pilates and water aerobics instructor. I am very small boned.
I recommend your doctor set you up for a 24 hour urine test and some other lab tests (e.g., vit D). If there is an electrolyte problem, this is the best way to identify it. Very difficult to know just based on standard blood tests.
Dr. Attia, there is no doubt your diet works because you look great.
What are your splits in the Olympic Triathlon (1.5K swim, 40K bike, 10K run)?
yuma, just because someone “looks good” doesn’t mean what they are saying has any merit, and vice versa. Don’t fall for this logic, or you will forever be chasing your tail and listening to charlatans. Don’t believe what I say because of how I look. Believe it because you can reason through it, and check it.
As for Olympic tri’s (or any tri’s) I don’t run…just swim and bike (but never together).
Dr. Attia, I was flabbergasted by your response.
My celebration of your physical condition was meant as a compliment on your achievements. I’m not looking for diet exercise gurus to follow blindly. Of course I’ll review all available facts before I decide to follow what anybody represents and decide accordingly. What do you think I am? Some kind of a stooge?
However, I will discard any guru that looks the opposite of what they preach no matter their “qualifications.”. That’s why I don’t pay attention to my doctor’s dietary recommendations. He tells me to go high carb low fat but it’s obvious to me that with his “beer” belly, it doesn’t work for him.
I’ve started low carb, not as low as you. So far I’ve lost 16 lb. in three weeks merely reducing carbs to about a hundred per day.
When I was young I was a competitive swimmer. With my additional energy and on going weight loss I want to start competing again in master races.
Since you and I are about the same height – although you have less weight and body fat than I – I figured that I could use your swimming time in the 1,500 meters free, the event I plan to resume competing at, as an achievable goal after I adopt your ketosis diet, which I plan to do.
However, if your swimming times are secret to prevent your competitors from gaining an unfair advantage on you, I’ll understand your silence.
Hope I didn’t offend you! Remember, the best coach is not necessarily the best athlete. Everyone has different genes and susceptibilities, so I’m not a fan of the approach that someone much look great to be right, or that someone who doesn’t look great can’t be right. As far as my times, there are no secrets to keep. 1500 free was never my thing. My best is about 21 minutes. Nothing to write home about. My sweet spot in swimming much much longer than 1500, or shorter non-freestyle events, primarily breaststroke and IM.
Hi Dr. Attia
I’ve for a period of around 6 months been doing a morning run of 10-11k for three of the five weekdays and some interval sessions during the weekends. In the same period I have reduced my carb intake while having a (too) low fat intake. I’ve gone from 139lbs (64kg) to 121lbs (55kg) at a height of 5’10”.
I would run at 5am, have breakast at 6am, a piece of fruit/carrots at 10am, lunch at 12pm, dinner at around 7pm and finally a very small meal around 9pm. The thing is now that I came to a back a couple of weeks ago where I had stop running after being very tired all the time, having some form of leg cramps, nosebleeds and a general lack of concentration. I’ve even been ordered by my doctor to not do any exercise an just start eating all the things I could (including cinnamon rolls etc.).
My thinking is that I’ve done some minor IF and at the same become more fat burning. Since I haven’t consumed enough fat the body has used what I had stored already. In addition, I think that I haven’t been aware that I’ve cut some of the regular sources for potassium and calcium, which would explain my symptoms. My point is that it’s not as much my weight which is the problem, it’s more the lack of fat and other nutrients in the diet which has made it come this far. Up until maybe just two to three weeks before I stopped running my times were still improving marginally and in the mornings I would feel pretty rested and ready to go for a run.
I know it’s difficult for you to give a good answer, but when I saw this post it simply reminded me so much of my own situation that I had to ask if this line of thinking makes sense to you?
Thank you for all the very good and easy-to-understand posts on this site!
Sounds like you’re a pretty lean and metabolically flexible person to begin with. Even more so now.
Hemming,
FWIW, I saw your post and thought I’d chime in. First off, in my opinion, you are doing a ton of cardio…basically 18 miles per week give or take; not including the interval work on the weekends. I used to be in that camp, running basically a marathon per week (usually 5 days per week at 5+ miles per clip). I lost alot of weight but was experiencing muscle weakness, lack of concentration, was tired, and not really losing much in the way of bodyfat. Not sure about your nosebleeds, but that can’t be good. Do you have high blood pressure? Sounds like you’re clearly pushing yourself to hard. That said, what I came to realize about the running, was that the chronic running is actually bad for you. When you exercise that way, you elevate your cortisol levels to the point that it starts to break down your muscle, which is converted to glucose which elevates your insulin levels which makes you store more fat. Cortisol is a catabolic hormone, not an anabolic one. Cortisol is useful in that it is integral to helping you get going in the morning; which is when it should be at its highest. It should be at its lowest in the evenings. But when your body is put under stress, cortisol rises. And if you think about, what happens when you’re really stressed out? You can’t focus on more than a few things; if at all, because your body is under stress and needs to focus on what is directly in front of it, so as to eliminate the stressor. Pretty cool how that works. Anyway, this clearly will impair your cognitive function, impair your long term memory, etc. Between the nosebleeds and the “chronic cardio” I would guess you are doing too much. In my opinion, I would cut out the weekly runs, and substitute them with walks, but keep the weekend interval training. Throw in some weight training 2-3 times per week and I’d bet you would start to feel a lot better.
Peter and Patrick, thank you for the replies.
My blood pressure is at the bottom of the normal range. I assume the nosebleeds has to do with lack of potassium, I have noticed it for around a week now.
I was definitely doing too much. Not only the cardio, but also working/commuting. As I said I’m now seeing my doctor at regular intervals where she takes blood samples and I have more or less stopped running.
My overall consideration was more that my doctor is focusing too much on my weight, when its actually more a matter of vitamin defiency (I think), I just wanted a second opinion on that. Do any of you agree with that? I know it’s hard (impossible) to tell over the internet, but I think you get my line of thinking. Anyway, I was just sort of looking for a second opinion as I feel I’m being accused of ‘eating disorder’
All the best,
Hemming
Peter, I’ve commented in the past on the old site and I’m back again. At the top of this post you express surprise that your “what I actually eat” post is so popular. I think I can answer that question. From my perspective this site, while a great technical resource is too complex for the average person looking for answers on how to eat healthy. After spending hours pouring through all the technical minutia you get exasperated and jut throw up your hands. The “what I actually eat” is a way to cut through all that and get to a real world translation.
I’ve read your ten posts on cholesterol but for the life of me I can’t figure out what cholesterol tests I should be having done. Or how I might try to explain to my physician why the standard cholesterol test is not helpful.
I see way down on the list of ‘coming soon” this subject: What tests to get done if you want to track your health.
I’m wondering if I’ll have already slipped into type 2 diabetes before you get to that. Put in terms of this post, how about a “What tests I actually get to track my health” post? I bet it would also be one of your most popular.
I get that this is not your full time job but if you are really interested in helping people that would be a good subject to tackle sooner rather than later.
Sean, I’d be happy to walk through all the tests I get on myself (I’m going to have my wife draw 10 tubes of blood tomorrow morning, as a matter of fact), but I’m not sure that’s going to help folks. If folks are struggling to understand the value of NMR for lipids after I dedicated 9 posts to the topic, how will one post on all the labs I do have much help? I worry it will only create confusion for people as they try to rationalize to their doctors why they need test X or test Y because “crazy” guy on his blog suggests it. What do you think?
yesterday my son the MD talked me into a KFC ‘double down’ which can be described as a low-carb perfect storm in the fast food world, at least the grilled version. only 460 calories (deep fried version is 560 i think). it was really good and very filling for its size: bacon, cheese, “12 herbs and spices”, 2 chicken fillets in lieu of a bun. it sounds and tasted like wretched excess, i.e. yummy.
it must have been dreamed up by some madman in the KFC marketing department and the idea somehow got green lighted when his colleagues were asleep at the wheel. OR it could be that the low-carb concept is finally penetrating the corporate types in the fast food world. OR, i dunno, it’s just a gimmick like deep-fried snickers bars to get attention.
have you had one and if so what’s your take.
I have not had one, but it does sound pretty good!
Hey Peter,
I have read some arguments that a prolonged period of Ketosis detrimental to liver function. Given what little I know about physiology and the Krebs cycle it seems as though this arguement carries enough weight that it
must be something you have looked into. Can you share what information you may have. I ve been looking for research on this to no avail.
Please excuse me if you’ve covered this before,
Julia
I am not aware of any credible information suggesting this.
Hello Peter,
Thank you for all the time and effort that you put into this blog. I thoroughly enjoy reading it! I am wondering what your opinion is on the big push for annual flu shots. I am a 43 yr old male. Do you think that they are a necessity? Do you get one?
Thank you!
Chris
Depends on your risk factors and exposures. Speak with your doctor. I get one, but I have enough risks to justify it.
Dear Dr. Attia,
I very much appreciate this site and all the hours of your thought and time to maintain it.
I am a physician in the Bay Area, and have been recommending VLCD for weight loss for my patients for years along with an NMR profile before embarking on this regimen. (I use specific labs when I request NMR, LP-IR etc) (I also recommend NMR for patients with Metabolic Syndrome, diabetes, those prescribed statins by another physician, and those who I am trying not to put on statins.) I strongly believe that nutrition and exercise are the basis for optimal health and any physician who knows nothing about these is sadly lacking and cannot possibly be providing the best care for their patients.
Thank you, again, for your commitment, passion and dedication to inform and educate.
I would be very interested in contributing to NuSI, not only fiscally, but also professionally.
Bonnes vacances!
C, I hope you can make patients in the Bay Area aware of your practice.
C,
I am located in the Bay Area and have been looking for a physician. I’ll echo Peter’s request to provide more information on your practice.
Peter,
I can’t begin to put into words my appreciation for the education you have provided me.
Thanks!
Mark
While I believe carb restriction is the way to go, I have yet to see any data or test measurements( ie NMR) that show that nutritional ketosis is better than a max carb intake of around 150. If for example your NMR results are at goal(LDL-P,etc as you have discussed) at an upper level of carbs of 150( via fruit, veggies, tubers) than why bother with nutritional ketosis? I am assuming all other health markers-weight,etc are fine. Additionally, I have not seen any benefit for health to mega hours of exercise. Of course if one is doing so for enjoyment, and has not developed an addiction then it is ok. But to much exercise not only creates wear and tear, but increases oxidation and possibly inflammation. There is a huge difference between health and fitness.
As a math guy, you certainly know about marginal and diminishing returns
Oh too well…Great question and we certainly don’t know the answer yet.
Great post. I am a 63 year old male who started following your dietary recommendations 2 weeks ago. I am going for a physical soon and would welcome suggestions about additional testing to complement the usual blood tests physicians order.
Thanks!
Check out some of the tests I’ve ordered on myself, which I’ve commented on throughout the various posts, including the cholesterol series.
hi peter,
i have been following a vlc nutrition for many weeks now, eating around 30 g of cho. i can’t afford to measure blood ketones, but i am a fat burner for sure. i tried out IF fasting too and i find it very useful especially in the way that it lets me organize my day not around meals times and i discovered that i can manage my hunger much better with the increase of ketones given from the fasted state.
there i something that does not add up though and i find no answer anywhere:
adding intermittent fasting to daily nutrition diminishes total calories intake naturally (fat amount intake dependent), which diminishes total protein intake. say that i need 90 g protein daily, if i have one or two meals per day, i am unable to reach that number with two moderate portions of 30 g. but…if i want to get to my requirement, i need to have a larger portion, which is likely to start a gluconeogenesis process that is likely to kick me out of ketosis.
what is your point of view?
That’s why it’s called IFIK.
HI Peter and all,
After about 6 months in ketosis I too have branched out and upped the carbs a bit. I’m now at about 50 to 100 per day. I just wanted to try this to see what happened, and wanted to have a bit more flexibility in my diet. I feel fine. I was surprised to find that I feel about the same when I work out as when in ketosis (i suspect this would not be the case with more endurance stuff like bike rides of a few hours–have not done those yet). I thought that at 75 gms per day I might have a lack of carbs that would leave me suffering in my workouts, but this is not the case at all. I typically get up in the morning, have a bit of coffee with just some cream, and then play basketball for and hour and a half or so.
However, I do feel different. As soon as I upped the carbs I started having feelings of hunger at various times in the day that had disappeared when in Ketosis. And, related to this I think, the Mindbody stability (still looking for the right way to describe this feeling) that I had in ketosis diminished.
I’ve stopped supplementing with sodium and potassium as well. I guess I just have one question: As you bumped up your carbs a bit in your latest chapter of experimentation, it looks like you continued supplementing with Sodium and Magnesium, but cut out the potassium? can you please explain why?
Thanks!
With enough sodium and magnesium I’m not having any issues with potassium.
Hi Peter – thanks for another great post. I wanted to ask a question of you. I’m a college senior, and while I have eliminated carbs from my diet entirely, I do still like to enjoy myself on weekends, and consume alcohol. Do you have any thoughts on how alcohol intake affects ketosis and fat metabolism? I don’t drink beer or sugary mixers, so I’m wondering what the impact of the alcohol itself would be, but at a rather high number of drinks.
Yes, check my responses to questions about alcohol in part I of this post. You may need to search, as my responses were in the comments section.
Hi Peter! Just wanted to follow up with one quick question. I noticed that you supplement with sodium. I have been low/no carb for almost a year now and have not been supplementing with sodium. I suppose this means that I am ‘deficient’ in my sodium intake. But, I don’t feel ‘unwell’ in any way, but maybe I should consider supplementing sodium as well. What are the short & long term consequences of being deficient in sodium intake?
If you don’t feel lousy and you’re not suffering any consequences of hyponatremia, you may not need to supplement.
Thanks for the reply Peter!
I suppose – as per your philosophy – it’s worth doing a self-experiment. Perhaps I’ve been in a ‘chronic’ hyponatremia and just adapted to the symptoms,
Quick question – how do you drink/eat your bouillon? I can’t seem to stomach it! (taking it with 250ml of water). Is there another sodium supplement you’d recommend for people who can’t deal with bouillon?
Mix it to a concentration you find palatable.